Arch Intern Med
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Comparative Study
Diagnostic yield of a positive fecal occult blood test found on digital rectal examination. Does the finger count?
The value of a positive fecal occult blood test (FOBT) found at the time of digital rectal examination is disputed. To determine the significance of a positive FOBT obtained in this manner, the records of 270 patients who underwent colonoscopy for any positive FOBT were retrospectively reviewed. Occult blood was found in 144 patients at the time of digital rectal examination and in 126 individuals after they submitted three spontaneously passed stool specimens. ⋯ The frequency of colonic abnormalities was similar with both stool collection methods in inpatients and outpatients. No statistically significant differences in neoplastic polyp or colon cancer detection rates, nor in the finding of hemorrhoids or other anorectal abnormalities, were apparent. Therefore, the belief that a positive FOBT found at the time of digital examination can or should be discounted as a false positive (because of the presence of hemorrhoids or other lesions prone to trauma at the time of digital examination) was not substantiated by this study.
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For the treatment of postoperative seizures and prevention of brain edema, an etomidate drip was used in conjunction with phenytoin, diazepam, pentobarbital, and phenobarbital in a 70-year-old woman. During a period of 24 hours, the patient received in excess of 479 g of propylene glycol, which was present at 35% (vol/vol) concentration in the undiluted etomidate. The propylene glycol toxic reaction resolved after the infusion was stopped.
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Surveillance of adverse reactions due to pharmaceuticals is important because the drug approval process cannot totally assure safety and because new knowledge is bound to accrue after drugs enter usual medical practice. Reporting of reactions to the Food and Drug Administration increased markedly between 1985 and 1989 and totaled 261,515 reports for this period. A large part of this increase was due to new legal requirements, which ensure that manufacturers report reactions to the Food and Drug Administration. ⋯ High proportions of the reports involved new drugs and serious reactions. Reaction surveillance leads to 50 to 100 important safety investigations annually and to numerous changes in product information. Health care providers must continue to report suspect adverse reactions to the Food and Drug Administration and manufacturers if pharmaceutical use and safety are to improve.